Transcript Nurse Practitioners Can Safely Provide Sole Resident Cover For

Nurse Practitioners Can Safely Provide Sole
Resident Cover For Cardiac Intensive Care Units
Nanjaiah P, Skinner H, Jutley RS,
Mitchell IM, McCartney S, Richens D
Trent Cardiac Centre, Nottingham
Drivers for Change
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Working hours restriction
Reduced attraction of CT surgery as a
career
Increased training time at expense of
service provision for NTNs
Immigration law
Shifts – lack of continuity of care
Proposed Solutions
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Merger of rotas – 1st & 2nd tier/H@N
Resident intensivists on site
Employ more non-career grade doctors
Enhanced role for Nurse Practitioners
Our Adopted Solution
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7 nurse practitioners
12 months training
CALS, drug prescribing, patient
assessment, data interpretation
Formal assessments, competency-based
Our Adopted Solution
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May 2010 – first-line cover weekdays
supported by resident registrar at
weekends
Sept 2010 – full first-line cover with nonresident registrar
Prospectively audited
Results
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7 month period
356 open-heart procedures – logistic ES
8.1(0.88- 84), mortality - 1.4%
82 calls made to medical staff
60% doctor attended
3 unheralded arrests handled by NP – all good
outcomes
No reported clinical incidents
Reason for Call
25
20
20
16
15
15
13
10
8
5
3
2
2
2
0
BLEEDING
LOW BLOOD
PRESSURE
LOW URINE
OUTPUT
AIRWAY OR
BREATHING
ARRHYTHMIA
ARREST
ACUTE ABDOMEN NEUROLOGICAL
STABLE BUT LOW
HB
Response to Call
35
32
33
30
25
20
16
15
10
5
4
4
THEATRE TEAM CALLED IN
OTHER
0
TELEPHONE ADVICE ONLY
JUNIOR SURGEON
ATTENDED
CONSULTANT ATTENDED
Resulting Interventions
18
16
16
14
13
12
10
9
8
6
4
2
0
4
3
3
2
Conclusion
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Radical changes to front line CICU cover appear
inevitable
A safe, sustainable alternative model has been
presented and is currently in use
Blood prescribing needs addressing
Training opportunity maximised
THANK YOU